1. The cost and burden of eye diseases and preventable blindness
Deloitte Access Economics
Italy
Copyright 2013 by Deloitte Consulting CVBA. All rights reserved.
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2. Executive Summary
Vision loss affects a large and growing number of individuals.
These individuals are impacted by reduced wellbeing and quality of life.
Leading to a loss in productivity and a large economic burden to society.
By investing in cost-effective interventions, vision loss will be avoided.
Resulting in a healthier, happier and more productive population.
As the U.S. population ages and changes demographically, the impact of vision loss and visual disability will grow substantially in the future.
loss of vision leads to disability, morbidity, and loss of productivity

3. This study quantified the economic impact of blindness and vision loss
Four eye diseases
Glaucoma
Diabetic retinopathy
Cataract
Wet age-related macular degeneration
Seven countries
Phase I – Italy and Germany
Phase II – France, UK, Spain and Slovakia
Phase III – Poland
Study Completion – end of November
Definition of blindness
For Italy, best corrected visual acuity of less than 3/60 (WHO)
Three outcomes
Burden of disease
Economic costs of disease
Cost effectiveness of interventions that can prevent or delay progression to blindness

4. Number of blind individuals in 2013
The economic impact was estimated by using the prevalence approach to costing
Number of blind individuals in 2013
Related financial and non-financial costs
Total costs
Costs included
Type
Definition
Direct
Healthcare
All costs within the healthcare system paid by government or other payers (incl. patients)
Indirect
Productivity
Income losses due to blindness for individuals of working age (15-64 years)
Informal care
Opportunity costs due to time spent on the provision of care for next of kin

5. Vision loss affects a large and growing number of individuals
Italy has a population of 60.7 million, and out of this population 218,513 individuals are considered blind according to the WHO definition (BCVA <3/60) (prevalence rate of 0.36%).
Many people in Italy suffer from cataract, diabetic retinopathy (DR), glaucoma, or wet age-related macular degeneration (AMD).
As the working population ages, more individuals will be affected by vision loss leading to productivity losses.
Prevalence of blindness and eye disease (number of people affected)
Population
Blindness
Cataract
Diabetic retinopathy
Glaucoma
Wet AMD
60,700,000
218,513
4,018,527
419,246
984,223
545,184

6. Estimated loss of wellbeing from eye diseases, DALYs in 2013
Individuals with eye diseases have a significantly reduced quality of life
A DALY represent one lost year of "healthy" life. The sum of these DALYs across the population, or the burden of disease, quantifies the gap between current health status and an ideal health situation.
Each individual eye disease leads to a significant reduction in DALYs.
Within eye diseases, wet AMD leads to the largest loss in quality of life.
The total loss in wellbeing is equivalent to 0.75% of the workforce in 2013.
Estimated loss of wellbeing from eye diseases, DALYs in 2013
* DALYs = Disability-adjusted life years, which represent one lost year of "healthy" life.
DR = Diabetic retinopathy, AMD = Age-related macular degeneration

7. These eye diseases also induce a large amount of healthcare costs
The direct healthcare costs of blindness are €336.8 million (€1,541 per blind person) in Italy.
Most of these costs (73.8%) are related to wet AMD
Proportion of healthcare costs for blindness by disease (€336.8 million)
This study estimated the combined economic impact of AMD, cataracts, diabetic retinopathy, glaucoma, and refractive error among Americans aged 40 years and older. The study estimated a total financial burden of major visual disorders of $35.4 billion comprised of $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses, in Annually, the federal government and state Medicaid agencies pay at least $13.7 billion of these costs.
*Indirect costs are financial impacts on society that are more broadly, outside the health care system.
DR = Diabetic retinopathy, AMD = Age-related macular degeneration

8. As well as a loss in productivity leading to a large economic burden
Blindness results in annual economic costs (direct and indirect*) of just over €2.0 billion in Italy (€9,309 per blind person)
Bulk of these costs are estimated to be due to informal care provision for blind people (68%)
Annual costs of blindness by type of costs
€2.0 billion
This study estimated the combined economic impact of AMD, cataracts, diabetic retinopathy, glaucoma, and refractive error among Americans aged 40 years and older. The study estimated a total financial burden of major visual disorders of $35.4 billion comprised of $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses, in Annually, the federal government and state Medicaid agencies pay at least $13.7 billion of these costs.
*Indirect costs are financial impacts on society that are more broadly, outside the health care system.

9. The economic impact of interventions was measured by cost-effectiveness analysis
Economic evaluation is the comparative analysis of alternative interventions in terms of both their costs and consequences in order to assist policy decisions.
The cost effectiveness of interventions are assessed using incremental cost effectiveness ratios (ICER), specifically the cost per DALY averted.
The WHO uses GDP as a readily available indicator to define three categories to assess whether interventions are worth their investment:
highly cost effective: cost per DALY averted less than GDP per capita;
cost effective: cost per DALY averted between one and three times GDP per capita; and
not cost effective: cost per DALY averted more than three times GDP per capita.
Incremental Cost Effectiveness Ratio =
Costs new intervention – Costs current intervention
Benefit new intervention – Benefit current intervention

10. The costs per outcome were extracted for four interventions and adjusted per country
ICER estimation and extrapolation methods
ICERs extracted from studies
Screening for cataracts (+ subsequent treatment)
Screening for Diabetic Retinopathy (+ subsequent treatment)
Glaucoma Eye Examination (+ subsequent treatment)
Anti-VEGF treatment for wet AMD
Max and Min estimated ICERs
Convert to Euros using PPP
Inflate to 2013 price using CPI
GDP per capita adjustment
Estimated ICERs for countries with C/E studies
Extrapolated ICERs for countries without C/E studies
ICER = Incremental cost-effectiveness ratio
PPP = Purchasing power parity (An economic theory that estimates the amount of adjustment needed on the exchange rate between countries)
CPI = Consumer price index, C/E = Cost-effectiveness
GDP = Gross domestic product
DR = Diabetic retinopathy, AMD = Age-related macular degeneration
Assessed against WHO thresholds for cost-effectiveness
1 x GDP = Highly cost effective
3 x GDP = cost effective

11. Three out of four interventions were considered worth their investment
Highly cost effective: Dilated eye evaluation to detect and treat cataracts (AMD, glaucoma and uncorrected refractive errors)
Cost effective: Anti-VEGF treatment for wet AMD
May not be cost effective: Technician-led glaucoma screening program for individuals aged >40 years if the prevalence is <4%
Glaucoma screening
Screening for diabetic retinopathy
Cataract screening
Anti-VEGF for AMD treatment
Interventions worth their investment
DR = Diabetic retinopathy, AMD = Age-related macular degeneration

12. Blind years and DALYs avoided per intervention Screening for glaucoma
Investing in cost-effective interventions has a big impact on reducing disease burden
Implementing DR screening (and subsequent treatment), screening for glaucoma (and subsequent treatment), and anti-VEGF treatment will result in prevention of up to 50,694 – 63,800 blind years per intervention
This will avert up to 3,760 – 28,829 DALYs per intervention
Blind years and DALYs avoided per intervention
DR screening
Screening for glaucoma
Anti-VEGF treatment
Blind years
DALYs
Lower limit
Upper limit
24,127
51,855
1,066
3,760
50,694
3,723 15,330
19,732
63,800
3,765
28,829
DR = Diabetic retinopathy

13. These interventions will offset a significant amount of economic costs to society
Each intervention can offset economic costs of €222m – €1.2bn
Cataract screening
Insufficient published information to estimate cost offsets due to blindness prevention

14. Vision loss can be avoided, resulting in a healthier and more productive population
Blindness and vision loss lead to reduced quality of life and increased economic burden to society.
In Italy, 218,513 individuals are considered blind.
Vision loss among the workforce due to aging leads to decreased productivity.
Eye diseases lead to a significant reduction of 16,989 – 96,901 DALYs.
Economic burden of blindness to society is €2.0 billion.
Cost-effective interventions offset economic costs of €222m – €1.2bn.
Investing in cost-effective interventions will lead to a healthier population, resulting in:
Reduced healthcare expenditure and more sustainable healthcare budget;
Increased tax-paying workforce that has increased productivity and has a longer working life;
Decreased costs and burden to informal care givers; and
Improved wellbeing and costs to patients.
Inclusion of screening, early diagnosis and adequate treatment of vision loss should be a health policy priority.